Long-Term Outcomes of Stay Alone Mitral Valve Surgery versus Concomitant Tricuspid Valve Repair—A Propensity Match Analysis

Objectives: To manage or not manage concomitant tricuspid regurgitation (TR) at the time of mitral valve surgery (MVS) is highly controversial. Aim of this study was to compare the long-term outcomes after stay alone mitral valve surgery (MVS) versus concomitant tricuspid valve reconstruction (TVR).

Methods: A total of 1,165 patients underwent isolated MVS and 192 patients underwent MVS with concomitant TVR. Propensity score matching resulted in 182 patients per group. Group differences for the overall (unmatched) population were abundant, but propensity matching resulted in two comparable patient groups without any statistically significant difference between them.

Results: The mean age of 63.9 years with atrial fibrillation (32.4%) being frequent and potentially associated with the mitral valve disease. The principal procedural difference between both groups was the length of intubation (median 13 for the combined procedure vs. 11 hours; p < 0.001), the X-clamp time (90.6 vs. 66 minutes; p < 0.001), the CPB time (136 vs. 95.5 min; p < 0.001) and the overall procedure time (224 vs. 176 minutes; p < 0.001). Slightly longer ICU and hospital stays did not reach statistical significance. In the Concomitant TVR group there was a strong reduction in the rate of grade III/IV tricuspid insufficiency after the operation (42.8% before and 1.7% postoperative and 3.4% after the long-term follow-up, respectively as would be expected. Rates in patients with stay alone MVR were comparable between baseline and after the intervention, but there was a slight deterioration seen after the long-term follow-up. There was no difference between the groups in terms of the overall rate of death within 30 days. Implantation of a pacemaker was required more often after MVS + TVR than after a MVR procedure (16.0 vs. 8.8%, p = 0.037). There were no significant between-group differences with respect to the rates of stroke, myocardial infarction, or repeat MV surgery. The estimated 7-year survival rate was identical for both groups (60.8% with and 57.5% without TVR; p = 0.794 from a long rank test) with a hazard ratio of 1.048 (95% CI: 0.737–1.492).

Conclusion: The long-term follow-up shows comparable good results in reduction of MV insufficiency and good recovery of LVEF but increasing TV Insufficiency II° in stay alone MVR. Even though double procedure in concomitant TKR group, 10-year survival rate was comparable to stay alone MKR group.